James C. Giudice

Benign Metastasizing Leiomyoma A Case Report and Review of the Literature

This is a case report of an asymptomatic, 65-year-old white female who was evaluated for multiple pulmonary nodules. This patients presentation, clinical course and pathologic specimens are consistent with benign metastasizing leiomyoma. A review of this rare disorder is included in this report with emphasis on past cases, clinical overview and treatment.

Acute upper airway obstruction—fiberoptic bronchoscopy in diagnosis and therapy

Twenty-two patients were referred over a 3-year period for endoscopic evaluation of the upper airways. The diagnosis of acute upper airway obstruction was suspected from clinical means, and 8 of the 22 did prove to have critical encroachment of the upper airways requiring tube passage for stabilization. This technique utilizing the fiberoptic bronchoscope for diagnosis and tube placement represents the approach of choice in the adult population with acute upper airway obstruction.

Computed tomography for diagnosis of tracheoesophageal fistula.

Two patients developed tracheoesophageal fistula after prolonged nasotracheal intubation and tracheostomy. The use of computed tomography, a noninvasive technique, to document the size and location of tracheoesophageal fistula may be preferable to endoscopic examination in critically ill, ventilator-dependent patients.

Pulmonary thromboembolism. 1. Current concepts in pathogenesis and diagnosis.

Thrombosis results from the dynamic interaction of venous stasis, hypercoagulability, and endothelial injury. Protection against thrombosis may be lost if there is deficiency of any of the factors that mediate platelet deaggregation, block fibrin deposition, or initiate fibrinolysis. A thrombus lodged in the pulmonary arterial circulation may remain hemodynamically and clinically silent or produce hemodynamic, clinical, and radiographic alterations. Although no signs and symptoms are specific to the condition, pulmonary thromboembolism can be diagnosed clinically if predisposing factors are taken into consideration. Diagnostic procedures include contrast venography, right heart catheterization, ventilation/perfusion lung scanning, and pulmonary angiography.

Pulmonary thromboembolism: 2. New trends in prophylaxis and therapy

Although low-dose heparin therapy is the technique most commonly used for prophylaxis of pulmonary thromboembolism, its usefulness is being questioned. Platelet deaggregation prophylaxis with either aspirin or dipyridamole, or both, apparently is a reasonable alternative, but further studies are needed. For treatment of pulmonary thromboembolism, continuous conventional-dose heparin therapy is the approach of choice. It has the highest therapeutic/toxic ratio and is the most effective technique for prevention of clot propagation. The patients fibrinolytic network must be intact, however, if clot degradation is to occur. Fibrinolytic therapy with urokinase or streptokinase should be restricted to use in patients with massive pulmonary embolism in whom hemodynamics are unstable. Caval interruption and pulmonary embolectomy have lower benefit/risk ratios than do the medical alternatives and are rarely used for pulmonary thromboembolism.